Ethics in NursingEthics in Nursing

EnieEnie NovieastariNovieastari, , SKp.,MSNSKp.,MSNDKKD FIK UIDKKD FIK UI

List of contentsList of contents

Definition of key termsDefinition of key termsEthics in nursing careEthics in nursing careNursesNurses’’ codes of ethicscodes of ethicsAccountability and responsibilityAccountability and responsibilityMoral reasoning and theoriesMoral reasoning and theoriesEthical principlesEthical principlesMethodology for ethical decision makingMethodology for ethical decision makingInstitutional ethics committeeInstitutional ethics committee

What is ethics?What is ethics?A term with many meaningA term with many meaningSimply stated, it is concerned with how people Simply stated, it is concerned with how people ought to act and how they ought to be in ought to act and how they ought to be in relationship with othersrelationship with othersConcerned with establishing norms and Concerned with establishing norms and standards for human life and conduct should bestandards for human life and conduct should beGood and bad, right and wrong, character or Good and bad, right and wrong, character or motivesmotivesMoral and ethics, used interchangeablyMoral and ethics, used interchangeably

EtikaEtika: : asalasal katakata ““ethosethos”” ((YunaniYunani kunokuno) ) dalamdalam bentukbentuk tunggaltunggal yang yang berartiberarti: : kebiasaankebiasaan, , adatadat; ; akhlakakhlak, , watakwatak; ; perasaanperasaan, , sikapsikap, , caracara berpikirberpikir. . DalamDalam bentukbentuk jamakjamak““ethaetha”” yang yang berartiberarti adatadat kebiasaankebiasaan((BertensBertens, 2007), 2007)EtikaEtika ~ moral~ moral dalamdalam bahasabahasaLatin Latin berartiberarti kebiasaankebiasaan, , adatadatSecaraSecara etimologietimologi etikaetika dandan moral moral samasama artiarti

MenurutMenurut KBBI (1999) KBBI (1999) EtikaEtika berartiberarti: : ilmuilmu tentangtentang apaapa yang yang baikbaik dandan apaapa yang yang burukburuk dandan tentangtentang hakhak dandankewajibankewajiban moral (moral (akhlakakhlak))EtikEtik berartiberarti: : 1. 1. kumpulankumpulan asasasas atauatau nilainilai yangyang

berkenaanberkenaan dengandengan akhlakakhlak2. 2. nilainilai mengenaimengenai benarbenar dandan salahsalah yang yang

dianutdianut suatusuatu golongangolongan atauatau masyarakatmasyarakatEtiketEtiket berartiberarti::1. 1. secariksecarik kertaskertas yang yang ditempelkanditempelkan padapada kemasankemasan2. 2. tatacaratatacara ((adatadat, , sopansopan santunsantun dsbdsb) ) dalamdalam masyarakatmasyarakat

Values and ethics are relatedValues and ethics are relatedValues: building blocks for personal and Values: building blocks for personal and professional morality, influence oneprofessional morality, influence one’’s ethical s ethical decision making, relationship and conductdecision making, relationship and conductValues are based on experience, religion, Values are based on experience, religion, education, and cultureeducation, and cultureA personA person’’s ethic flows from his/her valuess ethic flows from his/her valuesEthics is a study of good conduct, character, and Ethics is a study of good conduct, character, and motives, and concerned with determining what motives, and concerned with determining what is good or valuable for all peopleis good or valuable for all people

Ethics in nursing careEthics in nursing care

In nursing, specific values and moral In nursing, specific values and moral requirements are necessary to maintain requirements are necessary to maintain integrity of the professionintegrity of the professionAn ethical nurse will act and treat others An ethical nurse will act and treat others in specific ways that are consistent with in specific ways that are consistent with the nursing norms and will be guided by the nursing norms and will be guided by more than personal preferences or valuesmore than personal preferences or values

An ethic of careAn ethic of careCare: an action, a virtue, an affect, an ethical Care: an action, a virtue, an affect, an ethical principle, or a way of being in the worldprinciple, or a way of being in the worldCare as an ethic for nursing is concerned not Care as an ethic for nursing is concerned not only with the resolution of ethical dilemmas, but only with the resolution of ethical dilemmas, but also with the ways people behave towards one also with the ways people behave towards one anotheranotherAn ethic of care is concerned with relationship An ethic of care is concerned with relationship between people and with a nursebetween people and with a nurse’’s character s character and attitude toward others.and attitude toward others.

Nurses Code of EthicsNurses Code of EthicsNursing has developed code of ethics that Nursing has developed code of ethics that describe ideals for professional conductdescribe ideals for professional conductCodes reflect ethical principles widely accepted Codes reflect ethical principles widely accepted by members of the professionsby members of the professionsSee See KodeKode EtikEtik KeperawatanKeperawatan Indonesia:Indonesia:-- PerawatPerawat dandan klienklien-- PerawatPerawat dandan praktekpraktek-- PerawatPerawat dandan masyarakatmasyarakat-- PerawatPerawat dandan temanteman sejawatsejawat-- PerawatPerawat dandan profesiprofesi

Accountability and responsibilityAccountability and responsibilityNurse assumes responsibility and accountability for Nurse assumes responsibility and accountability for nursing care providednursing care providedResponsibility: execution of duties associated with the Responsibility: execution of duties associated with the nursenurse’’s particular roles particular roleExample: when administering the meds, the nurse is Example: when administering the meds, the nurse is responsible for assessing the clientresponsible for assessing the client’’s need for the drug, s need for the drug, giving them safely and correctly, and evaluating the giving them safely and correctly, and evaluating the responsesresponsesA nurse who acts in a responsible manner gains the trust A nurse who acts in a responsible manner gains the trust of client and other professionalsof client and other professionalsA responsible nurse: competent in knowledge and skills A responsible nurse: competent in knowledge and skills and demonstrates a willingness to perform within the and demonstrates a willingness to perform within the ethical guidelines of the professionsethical guidelines of the professions

Accountability means being answerable for oneAccountability means being answerable for one’’s s own actionsown actionsA nurse is accountable to self, the client, the A nurse is accountable to self, the client, the profession, the employer, and societyprofession, the employer, and societyIf a wrong dose of meds given, the nurse is If a wrong dose of meds given, the nurse is accountable to the client who receive it, the accountable to the client who receive it, the physician who ordered it, the nursing service physician who ordered it, the nursing service that set standard of expected performance, and that set standard of expected performance, and the society, which demands professional the society, which demands professional excellenceexcellenceTo be accountable, the nurse acts according to To be accountable, the nurse acts according to the professional code of ethicsthe professional code of ethics

The purpose of professional accountability:, The purpose of professional accountability:, To evaluate new professional practices To evaluate new professional practices and reassess existing onesand reassess existing onesTo maintain standards of health careTo maintain standards of health careTo facilitate personal reflection, ethical To facilitate personal reflection, ethical thought, and personal growth on the part thought, and personal growth on the part of health care professionalsof health care professionalsTo provide a basis for ethical decision To provide a basis for ethical decision makingmaking

Moral reasoning Moral reasoning ““Doing ethicsDoing ethics”” involves participating in a critical involves participating in a critical thought process about right and wrong, good thought process about right and wrong, good and bad, or thinking about situationsand bad, or thinking about situationsA process that occurs in many clientA process that occurs in many client--nurse nurse interactioninteractionDeveloping an understanding of the complex Developing an understanding of the complex thought process (moral reasoning) involved in thought process (moral reasoning) involved in processing ethical situations helps nurses processing ethical situations helps nurses participate more fully in the discussionsparticipate more fully in the discussionsMost moral reasoning happens after an ethical Most moral reasoning happens after an ethical situation has been recognized and before one situation has been recognized and before one acts on the situationacts on the situation

Emotions play an important role in ethical Emotions play an important role in ethical reasoningreasoningPeople feelings or emotions are different and People feelings or emotions are different and change in the same person from day to day or change in the same person from day to day or hour to hourhour to hourFeelings should be honored, acknowledged, and Feelings should be honored, acknowledged, and used as a consideration in moral reasoning used as a consideration in moral reasoning without making ethics simply a discussion about without making ethics simply a discussion about the validity and sincerity of individualthe validity and sincerity of individual’’s feelings feelingEthics is concerned with developing a system of Ethics is concerned with developing a system of shared values in a pluralistic societyshared values in a pluralistic society

Legal considerations also affect moral reasoningLegal considerations also affect moral reasoningIt is important to consider the law, the policies, It is important to consider the law, the policies, or the guidelines of policy and procedure in or the guidelines of policy and procedure in moral thinkingmoral thinkingEthics and laws are often in harmony, but not Ethics and laws are often in harmony, but not alwaysalwaysRelying on law as the primary consideration of Relying on law as the primary consideration of moral standards is a form of legalismmoral standards is a form of legalismFor example: refuse to act the request a For example: refuse to act the request a terminally ill, competent client to stop treatment, terminally ill, competent client to stop treatment, because of practitioners are afraid of being sued because of practitioners are afraid of being sued

Ethical principlesEthical principles

The most fundamental principle: respect The most fundamental principle: respect for personsfor personsThe 4 other primary principles stem from The 4 other primary principles stem from this basic principle:this basic principle:1. respect for autonomy1. respect for autonomy2. beneficence2. beneficence3. 3. nonmaleficencenonmaleficence4. justice4. justice

Autonomy: individual should have freedom Autonomy: individual should have freedom to choose their own life plan and ways of to choose their own life plan and ways of being moralbeing moralThe principles of The principles of nonmaleficencenonmaleficence and and beneficence are viewed on a continuum beneficence are viewed on a continuum ranging from not inflicting harm ranging from not inflicting harm ((nonmaleficencenonmaleficence) to benefiting others by ) to benefiting others by doing good (beneficence)doing good (beneficence)Justice: treating others fairly and giving Justice: treating others fairly and giving persons their duepersons their due

The secondary principles:The secondary principles:-- veracity: the duty to tell the truthveracity: the duty to tell the truth-- confidentiality; the duty to protect privileged confidentiality; the duty to protect privileged informationinformation-- fidelity: the duty to keep promisesfidelity: the duty to keep promisesInformed consent: promotes and respects Informed consent: promotes and respects autonomy by expanding the clientautonomy by expanding the client’’s knowledge s knowledge of his/her opinionsof his/her opinionsAdvance directives: a form of communication in Advance directives: a form of communication in which the persons can give direction on how which the persons can give direction on how they would like to be treated when they cannot they would like to be treated when they cannot speak for themselvesspeak for themselves

KerangkaKerangka pemecahanpemecahan masalahmasalah etiketik

MengembangkanMengembangkan data data dasardasarMengidentifikasiMengidentifikasi konflikkonflikMembuatMembuat tindakantindakan alternatifalternatifMenentukanMenentukan siapasiapa yang yang terlibatterlibat dandan siapasiapapengambilpengambil keputusankeputusanMengidentifikasiMengidentifikasi kewajiabnkewajiabn perawatperawatMembuatMembuat keputusankeputusan

PengambilanPengambilan keputusankeputusan etisetis

MenunjukkanMenunjukkan maksudmaksud baikngbaikng relevanrelevanMengidentifikasiMengidentifikasi semuasemua orangorang yang yang pentingpentingMengumpulkanMengumpulkan informasiinformasi yang yang relevanrelevanMengidentifikasiMengidentifikasi prinsipprinsip etisetis yang yang pentingpentingMengusulkanMengusulkan tindakantindakan alternatifalternatifMelakukanMelakukan tindakantindakan

ReferencesReferencesAiken, T.D. (2004). Aiken, T.D. (2004). Legal, Ethical, and Political Legal, Ethical, and Political Issues in Nursing. 2nd Ed.Issues in Nursing. 2nd Ed. Philadelphia: F.A. Philadelphia: F.A. Davis Company. Davis Company. Potter, P.A. & Perry, A.G. (2005). Potter, P.A. & Perry, A.G. (2005). undamentalsundamentalsof Nursing: of Nursing: ConcepsConceps, Process and Practice. 6th , Process and Practice. 6th Ed.St.Louis,MIEd.St.Louis,MI: Elsevier : Elsevier MosbyMosby. . KozierKozier, B., , B., ErbErb, , G.,BerwanG.,Berwan, A.J., & , A.J., & Burke,KBurke,K. . (2004). (2004). Fundamentals of Fundamentals of Nursing:ConceptsNursing:Concepts, , Process, and Practice. 6th Ed.Process, and Practice. 6th Ed. New Jersey: New Jersey: Prentice Hall Health. Prentice Hall Health. BukuBuku KodeKode EtikEtik KeperawatanKeperawatan Indonesia (PPNI).Indonesia (PPNI).